Case Study 2: NHS Leeds North CCG – Use of eFI to identify patients for medication reviews by Practice Pharmacists

In a nutshell: Older people with frailty should receive individualised medication reviews because certain medications are associated with increased risk of falls and delirium in older people with frailty. NHS Leeds North CCG Practice Pharmacists are identifying people with frailty using the eFI to then offer medication reviews and flag medications that are potentially inappropriate so that they can be adjusted or stopped.

Medication Optimisation Pharmacists working with GP Practices in Leeds North CCG are piloting the use of the electronic frailty index (eFI) to identify suitable patients for medication reviews. The Pharmacists are targeting the top 20-30 patients on the eFI report at each of the pilot sites. Early feedback based on the pharmacists’ clinical experience and intuition suggests that patients identified using the eFI are highly appropriate for medication review and the tool offers a reliable and efficient method of identifying these patients when compared with existing case identification methods.

The sensitivity of the eFI for identifying appropriate patients for pharmacist-led medication review will be compared with the existing search methods; this involves running opportunistic searches of the EHR using criteria such as housebound patients, patients on 10+ repeat medications, on the 2% Avoiding Unplanned Admissions lists, and clinician knowledge of the patients.

The overall aim of the programme is:

To compare the eFI with existing case-finding tools that are used to identify patients who will benefit from a pharmacist-led medication review

Outcomes being used to measure impact:

Reduction in prescribing costs

Number of medications stopped/started

Number of pharmacy interventions

Patient stories

If this process demonstrates value in identifying appropriate patients for medication review, the eFI will be adopted across all SystmOne practices in Leeds North; and latterly in EMIS practices when the eFI has been replicated.